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As Luck Would Have It ...

SECOND CHANCE Michael Kiernan has returned to his commute, but as a changed man.Credit
Robert Wright for The New York Times

FIVE days a week, Michael Kiernan, 50, a computer network administrator, makes the 90-minute commute home from the Bronx County Courthouse, where he works, to suburban Long Beach on Long Island. Like a lot of New Yorkers, he has it down to a science. He leaves work at 4:45, walk-jogs across 161st Street, then hurries into the subway, where he gets into the first car on the D train. He stands by the door, riding two stops to 145th Street, then races up the stairs for the A train, a downtown express. Again he stands, in the first car, by the third door, which at 34th Street opens at the stairs to the Long Island Rail Road. If all goes well, he catches the 5:20 home.

On Friday, Oct. 16, he was in his usual spot when the doors opened at 125th Street. Two court officers he knows usually get on, but didn’t, and he thought to himself that he must be the only one who’d made his connections just right. Then the doors closed, the train started, and he collapsed.

“Some lady started screaming and pointing to the floor,” said Anthony Medaglia Sr., 48, the labor relations manager at NewYork-Presbyterian/Columbia hospital, who’d gotten on at 168th Street. He, too, always sits in the first car, to catch the L.I.R.R. to Seaford, but was a half-hour earlier than usual that day, to get home for his son Anthony Jr.’s basketball game. “I thought it was a homeless person. He appeared to be having a grand mal seizure. He was flailing and foaming from the mouth, fists clenched, body tight. I figured the seizure would pass, but in seconds he turned a deep, deep blue. A frightening blue. Someone shouts, ‘Is there a doctor?’ ”

There was: Dr. Sonia Tolani, 32, a cardiology fellow at NewYork-Presbyterian/Columbia, fresh from work in green scrubs. She shouldn’t have been there either. She was supposed to still be at the hospital, but a colleague let her go a half-hour early because she was to be on call all Saturday. She too, always sits in the first car, which opens closest to her exit at 14th Street.

She pulled the man to the center of the train. “No pulse,” she said. “He was not breathing on his own. He was dead.” Dr. Tolani — in her first of four years of training to become a cardiologist — has performed CPR more times than she can count, but always in a hospital, mostly on frail people near death and usually without luck. She knew the odds from the American Heart Association: emergency medical services treat 300,000 people a year who suffer cardiac arrest at home, work or other public places, and fewer than 8 percent survive.

She knelt by him and began CPR, at a rate of 100 chest compressions per minute. Every two minutes, as trained, she stopped to check for a pulse. The pace is exhausting, and she asked if anyone else knew CPR. Mr. Medaglia, a former police officer who’d learned as a rookie at the academy in 1986, offered, and the rest of the way, they switched off every few minutes.

The next express stop is 59th Street, an 8-minute ride under optimum conditions, but this was Friday rush hour and the police estimate it took closer to 15. Mr. Medaglia, who was wearing a suit, became drenched from doing CPR, and Dr. Tolani later realized she had large bruises on her hands and knees.

As they pulled into 59th Street, the train’s emergency horn sounded, one long blast, one short. Commuters tried pushing on, but were shouted back by passengers. Extra police were at the station for a Yankees playoff game, and several came running. Dr. Tolani said she needed a defibrillator. “I was getting very nervous,” she said. By then, he’d been gone about 20 minutes.

If revived, she wondered, would he be brain-damaged? She assumed he’d suffered an arrhythmia. The heart quivers, like an engine stuck in neutral, unable to pump blood around the body. Through CPR compressions, they were manually moving his blood for him. “You hope the little oxygen left in his blood is enough to keep his brain and organs going,” she said.

There are 146 subway stations in Manhattan, according to transit officials, and 5 have defibrillators — including 59th Street. In a few minutes, Lt. Brendan Kelly arrived with one. This version didn’t have paddles, it had sticky patches, attached by wires to the machine. Dr. Tolani placed one patch on the man’s chest over the heart, the other on his upper back.

Sgt. Wakisha Roman began resuscitation, breathing into a tube connected to the man’s mouth. When Dr. Tolani noticed the stomach going up and down, she instructed Lieutenant Kelly to hold up the man’s chin, so the sergeant’s breaths reached the lungs.

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They stood back. Officer DellaUniversita pressed again. The machine said “charging,” then delivered the shock. The body arched and fell. Still no pulse. Two more minutes of CPR, a second shock. Nothing. “I’m thinking, ‘No way he’s coming back,’ ” Dr. Tolani recalled.

By then, firefighters had arrived and were preparing to administer oxygen. Lieutenant Kelly, still holding the chin up, noticed first. “I see the eyes start to move around in the aided’s head,” he said. “I hear a gasp.”

Dr. Tolani said: “He had a bounding pulse. I thought, ‘PULSE!’ ”

As the firefighters strapped the oxygen mask over his face, the aided tried to resist.

When he regained consciousness in the ambulance, he thought he was still standing by the third door. Before collapsing, he said, he had not felt lightheaded, nor had he experienced pain. “I just wasn’t there,” he said.

On the way to the hospital he gave medics his girlfriend’s cell number; he knew she’d be waiting at the Long Beach station and didn’t want her to worry. That night, at the hospital, he was on Facebook telling friends what happened.

Mr. Medaglia and Dr. Tolani rode the subway downtown together. “She said, ‘I want to apologize for having been so firm with you,’ and we laughed,” Mr. Medaglia recalled. He’d missed the 5:13 train and while he was waiting at Penn Station for the 5:59, a woman came up and said, “You did the CPR on that guy, is he really going to live?”

“I said I think so,” recalled Mr. Medaglia. “She blew me a kiss. She said, ‘God bless you — you did a great thing.’ I just sat on the train home, thinking, ‘Holy Jesus.’ ”

That evening, Dr. Tolani texted her mom and a few friends that she’d saved a man’s life, but they didn’t react much — they figured that’s what cardiologists do. She visited Mr. Kiernan a few days later at the hospital for a Channel 7 news report on the rescue and was struck by how “normal” he seemed. “I never had a patient go so quickly from dead to so alive,” she said.

This was Lieutenant Kelly’s fourth CPR call in 13 years. The three other aideds all died. “Best thing I ever did in my life,” he said.

Doctors believe Mr. Kiernan’s arrhythmia was caused by scar tissue from some unknown, previous cardiac event — perhaps a silent heart attack. They’ve implanted a micro-defibrillator in his chest to monitor his heart. After 5 days he was released, after 10 he was back at work. “I’m very thankful,” he said. “But it’s funny, it hasn’t hit me completely. I missed the whole thing. In some ways I think the trauma was worse for those around me.”

Having gotten a second chance, Mr. Kiernan, a lifelong bachelor, said he is trying to be a better partner to his longtime girlfriend and is trying to eat more carefully, drink less, and seize each day a little more. “I’m not religious,” he said, “but I keep thinking, ‘Who put that cardiologist on the train?’ Coming home tonight, I looked around the subway car — there wasn’t anybody who looked like a cardiologist.”

E-mail: Generationb@nytimes

A version of this article appears in print on November 8, 2009, on Page ST2 of the National edition with the headline: As Luck Would Have It ... Order Reprints|Today's Paper|Subscribe